Helping Your Loved One In & Out of Bed

Transfers from Bed to Chair: in many cases
there will most likely be times when the patient will wish to get
up out of bed. It may not be advisable for him to get up in some
cases. If there is a realistic danger that your loved one will
fall, he should not get up alone, and must be assisted by enough
people to assure his or her safety.

There are times when some hospice patients will repeatedly
request to get up out of bed, and then once in a chair, will soon
thereafter request to get back in bed...repeatedly requesting to
get in and out of bed over and over. In this case, the patient
may be suffering from what is called "terminal
agitation" or "terminal restlessness." This
problem can become exhausting to you, and the hospice RN case
manager and physician must be notified. There are several
medications commonly used to relieve this terminal agitation or
restlessness.

When a patient is suffering from various symptoms or pain,
moving can make things worse. If your physician has ordered pain
medications to be given on an as-needed basis, it is good to
administer pain medications at least one-half to one hour before
attempting to move him. Listen closely to your hospice RN case
manager for tips on managing pain before transfers.

You may find that your loved one will suffer from dizziness
after laying down for prolonged periods. If you have two persons
helping out, one person can lower the patient's legs over the
edge of the bed while the other simultaneously helps him to sit
up on the edge of the bed, supporting him at the shoulders. This
technique for sitting up is simple to accomplish (if you are
strong enough to support the patient) once you've watched
professional nurses demonstrate. After waiting for him to recover
from any dizziness, the transfer to a chair can be attempted (if
your RN case manager agrees).

Depending on the patient's strength, the distance to the
chair should be adjusted. If the patient is able to support his
weight and stand, a little walk to the chair is good exercise, as
long as someone is assisting him, supporting him by the arm to
steady him if necessary. If however, he is weaker, the chair
should be placed next to the bed without any space in between;
you may wish to use a transfer or gait belt which is applied
around the patient's waist, secured and which can be held to
support the patient's weight during the transfer. Watching
this done is helpful to learn safe technique.

When your loved one is feeling quite weak, it is important to
prevent falls to the floor and any injury that might result.
Watch how the hospice nurses assist your loved one. You will
notice that the nurse assisting him will place her feet and knees
directly in front of your loved one's feet and knees,
blocking them in place, preventing his legs from sliding out from
under him. Proper lifting technique will help you avoid injuring
yourself as well. Using the legs to lift, positioning your loved
one as close as possible to the chair, using a gait/transfer belt
to help him up, all of these techniques are helpful.

Assisting Your Loved One Back to Bed: If your
loved one has already fallen to the floor, do NOT move him or her
until you have determined if there has been an injury. If you
think there is a real chance that an injury has occurred, you
must get help from an RN or the EMS. If there has been no injury,
it is still important for you not to strain while helping him
back to the chair or bed. Get help when lifting him back up. If
you have any doubt about your own ability to assist him back up,
getting assistance from other family members, neighbors or
friends is appropriate. If there is nobody around who can assist
you, you may call the hospice for assistance. In some cases, the
hospice will advise you to call the EMS/ambulance for assistance.
Straining yourself in the process will only make things more
difficult for all involved.

If the patient has fallen to the floor, it is important to
notice if there has been any injury. If there has been an injury,
it is important to have an RN assess the patient before moving
him or her...or call your EMS ambulance to assess the patient. If
the patient does not appear to be injured, a useful method of
lifting is for two helpers to join in lifting simultaneously,
grasping each other's wrists under the patient's hips
with one arm and grasping each other's wrists behind the
patient's back & under his arms ( sometime's called a
fireman's carrying technique). Another method is to take a
strong blanket and spread that out on the floor next to your
loved one, and position him on the blanket...then using two to
four helpers, lift the patient by lifting the blanket up like a
stretcher.

It is important to have enough people assisting depending on
the weight of your loved one. Ask your RN case manager for
guidelines on moving the patient and to demonstrate methods for
assisting your loved one in and out of bed or up from the
floor.

Assisting to Bathroom: If you need to assist
him to the bathroom, the transfer or gait belt can be used as
well as using a walker or cane, if the patient is strong enough
to use them. Your loved one's ability to walk may become
unreliable, and you will need to carefully evaluate his ability
as you begin. If there is any indication he's unable to
safely transfer, then the attempt to get up should be stopped
immediately. Your hospice RN case manager will be able to give
you guidance.

If the patient is unable to walk so far, then a portable
commode may be placed next to the bed for his use, or a wheel
chair can be used. Privacy must be maintained. There is nothing
more humiliating to your loved one than sitting on the bedside
commode while visitors are present. It is appropriate to ask
others to step into another room during use of the bedside
commode or bathing. If the patient's bed is not in a private
bedroom, a sheet may be hung across the room for visual privacy
as well.